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State of CaPlarnia—Environmental Protection Agency <br /> Form ApproF °OMB No.2050-0039{Expires 9-30-99) See Instructions on back of page 6. Department of Toxic Substances Control <br /> Pleace print or type. Form designed for use on elite f 12-pik Uer. Sacramento,California <br /> aerator's US EPA ID No. Manifest Document 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS <br /> WASTE MANIFEST ARO 7�. 1,4 <br /> ? '� `7 is not required by Federal law. <br /> 0 <br /> 3. Generator's Name and Mailing Addres E DEPOT I A. State Mcnffest Document Number A e r <br /> 1806 Aston Avenue#100 2 4 4 <br /> 77 <br /> ;r, qpf4sbad.CA €I2008 803-360-3220 B. State Generator's ID <br /> n4. Generator's Phone( ) <br /> 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's IDLO <br /> IReserred.j <br /> CP SLAV INDUSTRIAL SERVICES, INC. 1;KIRDO 5`44613 D. Transporters PhoneOD <br /> F <br /> O <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. StateTransporter's ID Resented.] <br /> J <br /> F.Trcmeparleess Phone <br /> •Q <br /> V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. Stole Facility's ID <br /> 'Q POLLUTION CONTROL INDUSTRIES <br /> 4343 Kennedy Aver <br /> H. FacrTiys Phone <br /> O East Chicago, 1N 46342 1 JINPOPOP43 218.397.3 9 <br /> I� <br /> Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number 12. Containers 13. Total 14. Unit <br /> tJ P ( 9 Pe PP 9 I No. Type Oua6fity Wt/Vol 1. Waste Number <br /> m. <br /> 5E X a. (1�1�=`00#),'�aste Flammable Liquids. n.o.s., HC3. UN1933 j7 orate � <br /> Irms <br /> G Pall, (Paint/ SoNerds) (ERG#128) pr. EPA/C»her uFl� f fhl <br /> E _ <br /> N X b. Waste Toxic Liquids. Organic. n.o.s., l-°lC6.1, LjN2810, PG!l s"r� Dols <br /> E <br /> v R (Diazinon/Malathion) (ERG#453) EPA/0119UTSIMH <br /> v A <br /> g T X Waste Toxic. Solids, Organic, n.o.s., HC6.1, UN2811, PGIi <br /> ^o R (Diazinon d Malathlallt'I) (ERG #154) 13A G EeAf <br /> Z d' Ikon-RCRA, Non Hazardous Material stat t H <br /> U (Latex Paint) DrUj <br /> G EaAt <br /> J. AcfdiFional DeserfpRana far t+iateriufs Lls+ed K }fa Arig;CadeS lar lNaltds 1JstRd Al+ove <br /> 0, b.- <br /> LU <br /> Z 15. Special Handling instructions and Additional Information <br /> a <br /> HOME DEPOT ill 14D=6 25D Commerce Ali enue IN CASE OF EMERGENCY.CONTACT 3E AT&-0.4511.83A6 <br /> Z Proposal f 24401 Manteca CA 95336 Store Contact %139 <br /> W <br /> H <br /> Q16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> U marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national ger=n.t regu-660ns. <br /> A. <br /> If 1 am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economical) <br /> Npracticable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> and the environment;OR,if 1 am a small quantity generator,I have made a good faith effort Io minimize my waste generation and select�e best waste management method that is <br /> O available to me and that I can afford. <br /> Untteedd/TTynped Namse-. t ,. Signature ;�',/� / Month Day Year <br /> Z ..✓' S.f'1'k --•�Y <br /> w 1 r—a Inspi4ter 1 Acknowleclopment of Receipt of Materials Jw <br /> W A Pri / ed Signotu % M Ye <br /> w P j TG's/ lC C f✓ �7 E�'. <br /> U- 0 18. Tmaje2rier Acknowledgement of Recei4 of Materials <br /> O T Printed/Typed Name ; j._,' Signature �'�i Month Day Year <br /> w E --k-r <br /> Q R <br /> U F 19. Discrepancy Indication Space <br /> Z A <br /> C <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 8700-22 To: P.O. Box 400, Sacramento, CA 95812-0400 <br />